THIS TRAINING IS FULL! Please register below to get a spot on our wait list. We will award spaces in the training based on date/time of registration as well as giving preference to marginalized populations. Please check your email regularly for updates, as we will offer your spot via email and then offer it to someone else if we do not hear back from you within 24 hours. This training will be March 4 and 5, 2017, 8:30am-5:30pm, location TBD but will be within Seattle city proper.

* Required

Name *

Your answer

Email address *

Your answer

Phone number *

Your answer

What gender pronouns would you like us to use to refer to you? (e.g. she/her, they/them, he/him)

Your answer

I believe every person has the right to have children, the right to not have children, and the right to parent our own children in safe and healthy environments. *

True

False

Other:

If you like, provide an explanation for your answer above.

Your answer

Do you have any accessibility needs? We will do our best to accommodate them, given time and resources available.

Your answer

Which of the following apply to you? Check all that apply. (You do not need any previous experience to attend this training.) *

Doula

Doula-in-training

Certified Professional Midwife (CPM)

Certified Nurse Midwife (CNM)

Lay midwife

Student midwife

International Board Certified Lactation Consultant (IBCLC)

Other lactation specialist

Birthworker

Birthwerqer

Clinic escort

Reproductive justice activist

Feminist

Womanist

Mujerist/muxerist

Nurse

Nursing student

Doctor (MD)

Naturopath (ND)

Medical student

Mid-level healthcare provider (PA, ARNP, etc.)

Other allopathic health professional (EMT, CNA, MA)

Abortion provider

Abortion provider-in-training

Herbalist

Counselor or mental health therapist

Social worker

None of the above

Other:

Required

Are you a birth professional who will be on call during the training? *

Your answer

What experience do you have with abortion and/or abortion support? *

Your answer

How familiar are you with in-clinic and medication abortion procedures? *

Not familiar at all: little or no understanding of what kinds of procedures there are, what happens during these procedures, etc.

1

2

3

4

5

Very familiar: very knowledgeable about the kinds of procedures currently performed in the U.S., what those procedures entail, etc.

How familiar are you with herbal and other self care abortion options? *

Not familiar at all: little to no understanding of what kinds of abortion self care options there are or how they work

1

2

3

4

5

Very familiar: very knowledgeable about various abortion self care options and how they work

How familiar are you with anti-oppression concepts (anti-racism, anti-sexism, etc.)? *

Not familiar at all: no understanding

1

2

3

4

5

Very familiar: very knowledgeable

How familiar are you with the concept of reproductive justice? *

Not familiar at all: no understanding

1

2

3

4

5

Very familiar: very knowledgeable

How confident are you in identifying your own values, biases, and worldview, and navigating those frameworks in your day-to-day life? *